From virtual mistakes to real-world safety: Dr Laura Eastwood’s Topol Fellowship journey into Virtual Reality (VR) transfusion training

As a Consultant Clinical Scientist in Red Cell Immunohaematology at NHS Blood and Transplant, Dr Laura Eastwood works in a field where precision matters, and where small errors can have significant consequences.

Through her time as a Topol Digital Fellow, Laura set out to tackle a growing challenge within transfusion laboratories: how to ensure high-quality training in an increasingly pressured system.

At the centre of this challenge is crossmatching, a critical laboratory test that determines whether a unit of red blood cells is safe for a patient. While it can appear procedural, in reality it requires careful decision-making, attention to detail, and an understanding of complex rules that extend beyond a single test result.

As Laura reflects, the issue was not a lack of importance placed on training, but a lack of opportunity to deliver it effectively in busy laboratory environments.

Understanding the challenge

Data from Serious Hazards of Transfusion (SHOT) has consistently highlighted the risks associated with laboratory error. In the 2024 report, 22% of transfusion-related errors originated in the laboratory, with crossmatching playing a key role in the most serious incidents.

At the same time, workforce data from the UK Transfusion Laboratory Collaborative points to increasing workload pressures, staffing challenges, and the loss of experienced professionals.
Together, these factors create an environment where training can be difficult to prioritise, particularly for early career biomedical scientists and students, who are often learning in high-pressure settings.

For Laura, this raised an important question: could there be a different way to support learning?

Exploring a virtual solution

Working with NHS Blood and Transplant colleagues with expertise in training and digital learning, Digital Learning Consultant Eric Peotto and Ruth Evans, Lead for Scientific and Clinical Training and Education, alongside external immersive learning specialists, Laura contributed as subject matter expert to the development of the Crossmatch VR app.

The application recreates a transfusion laboratory, allowing learners to carry out a full crossmatch test in a virtual environment. From handling blood samples to selecting appropriate units and following laboratory processes, the experience is designed to reflect real-world practice as closely as possible.

One of the most powerful aspects of the project was the ability to safely explore mistakes.

Early in development, there were differing views on how far the training should go in showing the consequences of errors. Patient and donor representatives were understandably cautious about including outcomes such as morbidity or mortality. However, once they experienced the VR environment themselves, this perspective shifted.

Seeing how small errors could escalate into significant patient harm led to a shared understanding of the importance of including these consequences within the training.

As one participant fed back: “It was easy to use and decreased my anxiety because I knew it’s fine if I do make a mistake… it’s good to make mistakes in an environment where you can learn from them.”

Leading collaboration in a complex space

Alongside shaping the clinical content, Laura established and led a national stakeholder group, bringing together representatives from hospitals, patient and donor communities, and organisations including SHOT, UKTLC and the MHRA.

Bringing together a diverse group with different priorities and strong views was not without its challenges. It required careful facilitation, active listening, and a willingness to adapt in order to find common ground.

The development process followed a design thinking approach, moving through stages of design definition, scripting, alpha development and final delivery. Built using Unity and agile methodologies, the project evolved iteratively, with regular feedback shaping the final product.

The experience also brought unexpected moments. One highlight for Laura was joining a remote recording session, listening to a voice actor deliver lines from a script she had helped to write, and guiding them on the pronunciation of transfusion terminology - a reminder of how different digital projects can be from the day-to-day of traditional laboratory work.

Evaluating what works

A key focus of the project was understanding whether training in a virtual environment could translate into real-world practice.

An initial pilot study with undergraduate biomedical science students demonstrated a significant improvement in knowledge following VR training.

This was followed by a larger evaluation involving 103 biomedical scientists and trainees across 43 laboratories in England and Wales. Participants were divided into two groups: one trained using the Crossmatch VR app, and the other using traditional face-to-face methods.

The findings were encouraging. Both approaches improved knowledge and practical skills, with VR demonstrating comparable outcomes to traditional training. There was also a trend towards improved knowledge retention in the VR group after three months.

In terms of procedural learning, the VR group showed stronger performance immediately after training, with 89% completing all process steps in the correct order compared to 59% in the control group.
Feedback from both learners and trainers was highly positive. Learners valued the opportunity to practise in a safe, low-pressure environment, while trainers highlighted how VR made it easier to balance training alongside service demands.

Recognition and impact

Since its development, the Crossmatch VR app has gained recognition for its innovative approach to training. It was awarded the Gold Award for Best Use of Simulations at the UK’s 2025 Learning Technologies Awards, and received an accolade in the medical training procedure category at the 2024 International XR Awards.

Alongside the ABO and D grouping VR app, this work has also contributed to shortlisting in the 2026 IBMS Awards Training and Education category, highlighting its growing impact within the profession.

More broadly, the results demonstrate how immersive technology can support both learning and service delivery, offering a flexible, effective approach to training in busy healthcare environments.

The impact of the Topol Digital Fellowship

For Laura, the Topol Digital Fellowship was instrumental in making this project possible.

It provided the time and space to fully explore the problem before moving to solutions, something that can be difficult in routine practice. The emphasis on design thinking reinforced the importance of clearly defining the problem before developing an intervention.

The fellowship also supported the development of new skills, particularly in stakeholder management and leadership. Coordinating a national group with differing perspectives was a new experience, but one that proved invaluable.

Equally important was the confidence Laura gained in working with digital specialists, enabling effective collaboration across clinical and technical teams.

These skills have extended beyond the project itself and continue to influence her wider work.

Looking ahead

Reflecting on the development process, Laura identifies early stakeholder engagement as a key area for improvement. Bringing stakeholders together in person at the outset could have helped align expectations and build a shared understanding of what VR could offer.

This learning has already been applied to subsequent projects, including the development of an ABO and D grouping VR app, where an initial face-to-face workshop helped shape the direction from the start.

Final reflections

Laura Eastwood’s Topol Fellowship journey demonstrates how digital innovation can be used to address real-world challenges in healthcare training.

By creating a space where learners can practise, make mistakes, and understand the consequences without risk, the Crossmatch VR app offers a valuable addition to traditional training methods.

More broadly, the project highlights the importance of taking time to understand complex problems, working collaboratively across disciplines, and being open to new ways of thinking.

Ultimately, the goal remains the same: improving patient safety, one training experience at a time.